IGNOU Sample Internship File for MPCE015 MS

REPORT OF INTERNSHIP AT
UNIQUE PSYCHOLOGICAL SERVICES

PRESENTED TO THE FACU LTY OF THE
DISCIPLINE OF PSYCHOLOGY ,
SCHOOL OF SOCIAL SCIENCES, IGNOU

In partial fulfilment of the requirements for the degree of
M.A. Psychology (Clinical)

By:
Enrolment No:
Regional Centre: RC - Delhi 1
II
nd
Year ( batch), MPCE - 015
Agency Supervisor:
Academic Counsellor:

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DECLARATION

I, Mr. ,
hereby declare that I am a Learner of M.A. Psychology (Part II), year at
the study centre code 0713, Regional Centre RC- Delhi 1
and I want to do my Internship (MPCE015) at
Unique Psychological Services
on my own free will. I will adhere to the standards of the organization and
display professionalism during my internship.

Signature of the Learner Date:
Name of the Learner: Place:
New Delhi
Enrolment No.:

*Prepared as per the format in Appendix I of the Handbook on Internship (IGNOU, 2015)

49
APPENDIX-VII EVALUATION SCHEME FOR INTERNSHIP
(EXTERNAL EXAMINER)
Name of the Programme: Course Code:
Study Centre: Regional Centre:
Name of the Learner:
Enrollment No.:
External Marks (Viva Voce)
Details Maximum Marks Marks Obtained
Viva 40
Total Marks 30
Comments, if any: ____________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
____________________________________________________________________________
Signature ________________
Name & Address of External Examiner
__________________________________
__________________________________
Date:
Note: The marks given by the External Examiner are to be entered in the Award Sheet along
with the internal marks received from the Study Centre at the time of TEE of Internship.

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ACKNOWLEDGEMENT
This internship would not have been possible without the kind support and help of my supervisors
and
colleagues and I would like to extend my sincere thanks to all of them.
AGENCY SUPERVISORS
I am highly indebted to
for their valuable guidance and
supervision during the
internship at their organisation – Unique Psychological Services. The internship
program has been designed by them in a manner that gives exposure to case history taking/MSE, child and
adult psychopathology, basics of therapy, school counselling and psychodiagnostic assessments. They also
take care of dimensions such as building confidence in client-handling
which are key to becoming a good
practitioner.
FELLOW INTERNS AND STUDENTS
I would also like to thank the staff and special educators at
UPS –

for making themselves available to answer my questions. I would also like to thank my fellow
interns and
students of the other programs at UPS/Unique Institute of Behavioral Sciences

for sharing their knowledge with me and
making the entire process of learning a pleasant experience.
ACADEMIC COUNSELLORS
I would like to express my gratitude towards
M

academic counsellors, Jesus and Mary College, for motivating and
guiding the entire batch
regarding various requirements of the course.

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TABLE OF CONTENTS
Certificate of completion of Internship by agency i
Consent letter duly signed by the agency supervisor (Appendix III) ii
Declaration duly signed by the learner (Appendix I) iii
Certificate duly signed by the learner, academic counsellor and agency supervisor iv
Evaluation scheme for Internship – Agency Supervisor v
Evaluation scheme for Internship – Academic Counsellor vi
Evaluation scheme for Internship – External Examiner vii
Acknowledgement viii
I. Introduction 2
II. Profile of the Organisation/Institution 4
III. Case and Activity Reports 6
 Case 1: G. Gupta – Attention Deficit Hyperactivity Disorder
 Case 2: B. Sharma – Asperger’s Syndrome
 Case 3: S. Verma – Conduct Disorder
 Case 4: R. Gupta – Obsessive Compulsive Disorder
 Case 5: A. Singh – Somatoform Disorder
 Case 6: D. Sahni – Development Disorder of Scholastic Skills
 Case 7: H. Singh – Attention Deficit Hyperactivity Disorder
 Case 8: P. Khanna – Psychoactive Substance Use
 Case 9: P. Aggarwal – Personality Disorder
 Case 10: N. Kumar – Obsessive Compulsive Disorder
8
16
26
34
44
51
60
67
75
82
IV. Discussion 90
V. Appendixes 91
 Case format used
 Record of visits/activities carried out by learner
 References
92
98
100

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INTRODUCTION
Internship is an important component of the MA Psychology Programme of IGNOU. It provides learners
with an opportunity to integrate theoretical knowledge, research, and skills
in clinical psychology. There is
one to one supervision and the learner is closely supervised by the supervisor who gives feedback about
h
is/her performance.
The
objectives of the internship include providing comprehensive training in the field of psychology, help
develop skills and techniques to provide the needed services to individuals, groups and organizations,
developing
professional competence, and encouraging maintenance of the highest standards in offering
psychological services. The
learner, thus, learns and acquires skills and professional acumen under trained
practitioners in the concerned setting.
This internship was carried out for a period of more than 2
50 hours over a course of 45 days from
under the direct
supervision of , Director cum Clinical Psychologist,
Unique Psychological Services (UPS)/Unique Institute of Behavioral Sciences (UIBS), and her staff.

The internship helped me to get hands on experience in the area of Clinical Psychology. I was given the
chance to assess clients and learn the planning of strategies to help clients from different settings to
overcome their problems. I also learnt to deal with diverse population including children, adolescents and
adults. I also learnt to conduct tests and assessments and properly interpreting the results emerging from the
testing.
Activities carried out during the internship include assessment and diagnosis, including interviewing, case
history taking, administration of psychological tests, scoring and interpretation of the test results and
arriving at
correct diagnosis of the problem. I also got the opportunity to be involved in/observe providing
psychotherapy, behavioral treatment, assessment and working with an interdisciplinary treatment team
including special educators.
This report covers
a selection of ten such cases that were either handled or observed by me . It includes
details about the psychological testing (if applicable) and intervention carried out.
INTERNSHIP AT UPS
UPS
is an organization run by two competent clinical psychologists who are registered with RCI and have a
rich and diverse work experience. The objective of their internship programs is to develop
skilled,

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knowledgeable and qualified psychologists
who have practical know how along with the theoretical
knowledge.
The training includes role plays, discussions,
client observation, detailed case studies and close supervision
of cases handled. It emphasizes on practical aspects of clinical practice; the skills needed to be an effective
counselor and a psychologist; skills needed for patient handling; deciding how, when and why to choose a
psychological test; how to write a psychological report and basics of therapeutic process. In addition, some
theory classes focusing on the basic concepts are also taken.
The internship program has been designed in a manner that gives exposure to case history taking/MSE, child
and adult psychopathology
(especially childhood disorders like learning disability, ADHD, behavioral
problems etc.), basics of therapy
and therapeutic interventions, relationship counselling, school counselling
and psycho-diagnostic assessments. It also takes
care of dimensions such as building confidence in client-
handling
which i s key to becoming a good practitioner. Highlights of the program include supervised
training, direct case handling, first hand psychological testing,
first hand counselling exposure and
supporting theoretical classes
.
Considering both UPS and the internship program at UPS fulfil the requirements of the MAPC programme
and the criteria set by IGNOU, I chose to do
my internship at this organization.

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PROFILE OF THE ORGANIZATION
Unique Psychological Services (UPS) is an organization founded
by
(Clinical Psychologists
registered with Rehabilitation Council of India - RCI, Government of India)
to d
eliver quality mental health services. It is functioning for more than five years now and is a continuously
growing organization.

MISSION
UPS aspires to provide highly specialized, authentic, confidential, professional counselling
services
throughout the globe in difficult moments at all times, thereby enabling a person to live a happy, holistic and
a gratifying life. It
desires to create a highly professional, certified and experienced team of professionals
who have been intensively trained in various disciplines to listen, understand, help and assist clients.
It aims
to help
individuals lead a happy, meaningful and problem-free life and focuses on the concept of holistic
health -
healthy mind, health body and healthy soul, and, aspires to provide solutions to various problems
one faces at different phases and walks of life.
OBJECTIVES
The
multi-fold objectives of UPS are:
1.
To offer Psychological services across the globe to enable individuals and families to lead a
successful meaningful life.
2.
To raise awareness, understanding and acceptance of various psychological concerns.
3.
To promote effective coping skills, life styles, life skills and strategies aiming at mental well-being.
4.
To conduct research into various psychological issues, their impact on the individual and society at
large and to discover effective ways of dealing with them.
5.
To encourage inputs from and discussions with the entire community of academicians, students,
parents, corporates, professional associations, government organizations
etc.
6.
To provide quick and practical solutions that come handy in dealing with everyday difficulties and
concerns.
SERVICES
UPS
provides one-to-one psychological services including counselling, psychodiagnostics and
psychotherapeutics in-person, telephonically
and online depending on the situation. It caters to various

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problem areas -
child related issues, adolescence related issues, relationship issues, psychiatric issues, work
related issues, d
rug addiction, life skills training, career guidance and health psychology. UPS also conducts
employee assistance programs
and provides de-addiction and rehabilitation services.
EXPERTISE
UPS has an
integrated team of highly qualified, registered professionals having rich experience in the fields
of psychiatry, clinical psychology, cou
nselling, special education, speech therapy, occupational therapy,
forensic psychology, medicine, nutrition, Yoga, law and HRD. The team has extensive experience with
renowned h
ospitals, psychiatric clinics, NGOs, schools and MNCs across the country.
The
counselling team is highly specialized and possesses post graduate qualifications in the respective
fields. Each
individual has undergone specialized training in counselling, psycho-diagnostic and
psychotherapeutic techniques to ensure optimum quality of service delivery.
- CHILD & CLINICAL PSYCHOLOGIST

is M.Phil in clinical psychology from IHBAS, Delhi University - a double
gold medalist.
She was part of the pan-India CBSE telephonic helpline panel and works actively in various
school and clinical settings dealing with normal children and children with problems. She is involved in conducting talks and workshops on various psychological concerns for children, teachers and parents in
schools and also on channels such as AajTak, Sahara, DD Bharti and AIR FM etc. She has written several
books and her articles are a regular feature in various newspapers and magazines.
- DIRECTOR & CLINICAL PSYCHOLOGIST

is M.Phil in clinical psychology from IHBAS, Delhi University. He has a rich
experience in
dealing with issues related to relationship counselling, teaching and training psychology
students,
dealing with psychological concerns in colleges and clinical settings, conducting talks and
workshops on various psychological concerns for psychology students. He has been featured on Pragya TV
and AIR FM etc. He has written various books and his articles are a regular feature in various newspapers
and magazines.

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CASE AND ACTIVITY REPORTS

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INTRODUCTION TO THE SECTION
In this section, a selection of ten cases out of the numerous cases observed during the internship are being
presented.
The cases have been selected to cover a broad variety of clinical issues. However, the primary
clientele of UPS is children suffering from Disorders of Psychological Development covered in F80-89 of
ICD 10 (World Health Organisation, 1993), Mental Retardation covered in F70-79 and Behavioral and
emotional disorders with onset usually occurring in childhood and adolescence
covered in F90-98.
Therefore, my internship was automatically focused around these, as a result of which this report is
predominantly dominated by such cases.
In this report, the name of the client, and other sensitive information
that could help identify the client, has
been replaced with a dummy placeholder for confidentiality reasons in line with the guidelines in sec. 4.06
and 4.07 of the Ethical Principles of Psychologists and Code of Conduct (American Psychological
Association, 2010). Section 4.06 states that:
“…psychologists
do not disclose confidential information that reasonably could lead to the identification of
a client/patient, research
participant, or other person or organization with whom they have a confidential
relationship unless they have obtained the
prior consent of the person or organization or the disclosure
cannot be avoided,…”
Section 4.07 states that:
“Psychologists do not disclose in their writings, lectures,
or other public media, confidential, personally
identifiable
information concerning their clients/patients, students, research participants, organizational
clients, or other recipi-
ents of their services that they obtained during the course of their work, unless (1)
they take reasonable steps to disguise
the person or organization, (2) the person or organization has
consented in writing, or (3) there is legal authorization for doing
so.”
Also, respecting the copyright that the creators of various tests and assessments hold over
their creations, I
have avoided going into
item wise details anywhere in the report. This is especially true of those checklists
etc. which are proprietary UPS material.
Therefore, a brief overview of the tests and assessments
administered to the clients has been d
iscussed to the extent that it is satisfactory for the purpose of getting an
understanding of the case.

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
He indulges in socially inappropriate behavior.
IV. OTHER RELEVANT INFORMATION
Father is in the army and has been transferred to Guwahati. He appeared to be dominating, while the mother
appeared to be submissive. This may be the reason why authority of the mother is not in place. The
mother
would be living alone with the child after the father leaves. Considering situation is in control because of his
respect for father’s authority, parents are worried that situation may become difficult to manage.
V. OBSERVATIONS REGARDING CASE
Client was found to have average intelligence, average chance of ADHD and several behavioral concerns. The intervention listed in the next section has been planned on this basis.

Average Intelligence: The test findings on MISIC suggest that the child has an IQ of 105 suggestive
of Average Level of Current Intellectual Functioning.

Average probability of ADHD: ADHDT assessment indicates that the probability that he has
ADHD is average. ADHD is listed under F90.0 Disturbance of activity and attention in ICD10
(World Health Organisation, 1993).


Several behavioral concerns: The assessment indicates behavioral issues on several dimensions. A
diagnosis of F91.0 Conduct Disorders (World Health Organisation, 1993) may be considered.
VI. INTERVENTION REQUIRED
Recommendations for Parents
1.
For client’s inattention and poor concentration span

Parents need to engage the child in brain gym exercises such as, grain sorting etc. to enhance
his attention and concentration span.

Give child one instruction at a time.

Ask child to repeat instructions before carrying it out to ensure that he has understood it clearly.

Avoid food items containing sugar and artificial colors as they are likely to increase the child’s
hyperactivity and inattention.

Positive home environment and support of the family members should be strengthened.

To reduce distractibility, while teaching him: use a corner setting, keep one book at a time on
the study table, give several short breaks and involve the child in the task.

Pharmacotherapy is likely to help
2.
For behavioral concerns

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
Parents should use token economy and differential reinforcement strategies

A daily routine should be made for him and strictly followed

Child needs a firm, consistent and disciplined parenting
Recommendations for the School
1.
For client’s inattention and poor concentration span

To prevent distractions client should be made to sit in the first bench of the middle row neither
near the window nor near the door, should be given one assignment or instruction at a time
p
referably in written, and, buddy system can be used for him.

One to one attention whenever possible can be given to him

As per CBSE guidelines, child should be given extra time in exams to help him perform better

His positive involvement in school and extra – curricular activities should be encouraged to
help build his self-esteem and self-confidence.
2.
For behavioral concerns

Use behavior modifications strategies such as token economy and differential reinforcement

Buddy system can be used for him in the class, where a responsible child can be made to sit
with him who keeps a check on his behavior and reminds him to engage in correct behaviors.

For correct behaviors he needs to be appreciated and responsibilities can be given to him.

* * *

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3.
Emotions: He does not seem to experience significant difficulty in expressing or comprehending or
verbalizing his emotions and sometimes tends to over react
on small issues and get very aggressive.
In anger he tends to scratch and punch others. One needs to bribe him to calm him down.
4.
Egocentrism: He appears to be quite egocentric and almost always wants others to act according to
his wishes and wants. He can follow dates and time and can do mental math adequately.
He feels
insecure when alone. Tends to mess up the game and throw things if he’s losing.
5.
Communication: No significant difficulties in non-verbal communication are seen. He does not
seem to be clear with the concept of social distance and tends to get quite close to girls while talking
making them feel uncomfortable. He’s comfortable hugging or kissing
only people close to him.
6.
Restricted Interests: He displays presence of restricted interests. He tends to show a keen interest in
mythology and history and tends to remember immensely minute details. Food is another key area of
his interest on which he can talk for several days altogether.
7.
Unusual use of language: Engages in professor talk and talks to others in a manner as if he knows
better than them. He realizes when
the other people lose interest in talking to him and tell them to
refocus and pay attention to what he is saying. Can understand and enjoys jokes and metaphors well.
8.
Co-ordination: No significant deficits in his visuo-motor co-ordination are seen. He can play tennis
fairly well. He shows discomfort with some textures such as food items that are too soft.
9.
Unusual physical mannerisms: He tends to get very aggressive and tends to dig nails into other
people and punch others
10. Other concerns:
He displays extremely ill-mannered behavior and doesn’t seem to respect and tends
to defy authority. He at times lies to avoid getting scolded. He is extremely messy with food and
tends to drop food a lot while eating and tends to dirty clothes, table and belongings.
4
. CAT
The interview was done in the same room after the previous test was completed. The client was told that he
will be shown some cards and he has to construct stories around the cards. The stories should cover the
characters in the card, what they are thinking and feeling now, what happened to them in the past and what
will happen to them in the future. After this the cards were shown to him one by one and the stories
recorded. This was followed by conducting an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:

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The client’s responses on CAT suggested average intelligence (presence of internal consistency and logical
development of stories; adequate organization level; average vocabulary).
His personal, family adjustment seems to be adequate. He is likely to share cordial relationships with his
parents and siblings but tends to perceive peer rejection. He feels that his peers mock at him and use derogatory
language for him which certainly troubles him.
Based on the stories made by him, it becomes quite evident that often his thoughts are dis-jointed and he fails
to comprehend cause and effect relationships. Absence of adequate connections between his thoughts was
seen. He was also seen to have difficulty prioritizing things according to their degree of importance. When it
comes to social situations, he tends to assess them in parts and fails to see the
larger picture which may make
it difficult for him to deal with peers and various situations consequently. He was seen to give a personalized
meaning to events which may not be always correct thus making him jump to erroneous conclusions.
His dominant needs appeared to be the need for autonomy, aggression, affiliation, and succourance. His major
conflict seems to be the conflict between autonomy vs compliance. His ego functioning and problem solving
skills seem to be poor (absence of clear outcomes). He seems to be in adequate touch with reality (inclusion
of all the central dominant parts of the pictures; absence of perceptual distortion).
IV. OTHER RELEVANT INFORMATION
-
V. OBSERVATIONS REGARDING CASE
Client was found to have average intelligence and average chance of ADHD. He has Aspergers’ syndrome
and several intra-psychic issues are present. Intervention in the next section has been planned on this basis.

Average Intelligence: The test findings on MISIC suggest that the child has an IQ of 100 suggestive
of Average Level of Current Intellectual Functioning.

Average probability of ADHD: ADHDT assessment indicates that the probability that he has
ADHD is average. ADHD is listed under F90.0 Disturbance of activity and attention in ICD10 (World Health Organisation, 1993).


Asperger’s: The client meets the diagnostic guidelines for F84.5 Asperger’s Syndrome, ICD10
(World Health Organisation, 1993)

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
Intra-psychic conflicts: On CAT, he was seen to personalize things and absence of adequate
connections between his thoughts was seen and tends to make erroneous conclusions. His ego-
functioning and problem solving skills were poor.
VI. INTERVENTION REQUIRED
Recommendations for Parents
1.
For client’s social concerns

Social skills training is recommended: Social skills can be increased by using visual techniques
like social stories and behavioral skill training programs in various social situations.

Group participation needs to be encouraged in a graded fashion

He needs to be kept up-dated with various social events or festival taking place.
2.
For emotional concerns

Critical comments and comparison with other children should be avoided.

He should be appreciated for the improvement he shows no matter how small the improvement
may be. He should be motivated to perform to his best potential.

The parents need to carefully look for strengths, interests or skills the child may have.

The strengths of the child should be emphasized as a sense of accomplishment and pride is
likely to give him the confidence to persevere when he faces challenges or difficulties.

He needs to be given clear, consistent and structured instructions always.

Equip him with the possibilities of social rejection, peer rejection and the frustration he may
face in future because of rigidities and audacities seen in his behavior
3.
For inattention and poor concentration span

Parents need to engage the child in brain gym exercises such as, grain sorting etc. to enhance
his attention and concentration span.

Give child one instruction at a time.

Ask child to repeat instructions before carrying it out to ensure that he has understood it clearly.

Avoid food items containing sugar and artificial colors as they are likely to increase the child’s
hyperactivity and inattention.

Positive home environment and support of the family members should be strengthened.

To reduce distractibility, while teaching him: use a corner setting, keep one book at a time on
the study table, give several short breaks and involve the child
in the task.

Pharmacotherapy is likely to help
4.
For poor eye to eye contact

Eye tracking exercises need to be given

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Recommendations for the School
1.
For social concerns

Teachers at school need to be sensitive to him and need to understand that the inappropriate
behavior displayed by Bharat is not intentional bad behavior.

He genuinely lacks the basic social skills and emotion regulation skills.

Teacher need to be patient and give him clear and explicit instructions as far as possible to
ensure that he does the assigned task adequately.

Rejection by peers need to be addressed

Classmates need to be made sensitive to Bharat’s needs

Group participation needs to be encouraged and basic social skills need to be taught to him
2.
For emotional concerns

Avoid scolding Bharat for little things

Concept of social distance needs to be taught

In case of an emotional outburst, he should be allowed to go out of the class and settle himself

Anger management strategies needs to be taught to the child

He needs to be given attention for correct and desirable behaviors.
3.
For client’s inattention and poor concentration span

To prevent distractions client should be made to sit in the first bench of the middle row neither
near the window nor near the door, should be given one assignment or instruction at a time
p
referably in written, and, buddy system can be used for him.

One to one attention whenever possible can be given to him

As per CBSE guidelines, child should be given extra time in exams to help him perform better

His positive involvement in school and extra – curricular activities should be encouraged to
help build his self-esteem and self-confidence.
4.
For behavioral concerns

Use behavior modification strategies such as token economy and differential reinforcement

* * *

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10. Insight
Absent
III. PSYCHOLOGICAL TESTS ADMINISTERED
In order to understand her current level of functioning in the emotional sphere of life and to gain a better
understanding of her present condition, the following tests were administered:
1.
For intra-psychic issues: Children’s Apperception Test (CAT)
2.
For intra-psychic issues: Sac’s Sentence Completion Test (SSCT)
3.
For understanding her interest areas: RP Singh Interest Record (RPSIR)
The SSCT was conducted by the agency supervisor herself, while I conducted the CAT and RPSIR.
The
details of the assessments are given below:
1.
CAT
The client was taken to a silent room so that she doesn’t get distracted while doing the assessments. While
going to the room I engaged the client in a general discussion to establish rapport with
her. The client was
told that she will be shown some cards and he has to construct stories around the cards. To motivate her to
perform we had to present the test as a test of creativity. The stories should cover the characters in the card,
what they are thinking and feeling now, what happened to them in the past and what will happen to them in
the future. After this the cards were shown to her one by one and the stories recorded. This was followed by
conducting an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
The client’s responses on CAT suggested average intelligence (presence of internal consistency and logical
development of stories; adequate organization level; average vocabulary).
Unlike her social adjustment, her personal (presence of more negative emotions like anger, hurt, abandonment,
frustration etc. than positive emotions), family adjustment level seems to be poor. The hero was seen to carry
ambivalent feelings towards her parents (seeing death and injury of parents and family members). Parents
were usually seen in a disciplinary role and the hero tended to lie at
times to avoid being corrected.

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Most of the stories made by her centered on the theme of a family in which siblings were seen to fight among
each other trying to prove who is better. Each one having a strong need to be noticed and paid attention to.
The hero of her stories was seen to carry an extremely negative attitude towards most of the authority figures
who were in the position of correcting her and did not seem to give in unconditionally to all her demands.
Presence of extreme opposing emotions was seen and she may be carrying negative feelings or opinions about
self. The hero felt that her parents tend to display anger towards her in a disguised form and the hero was seen
to inflict pain or punish her parents for feeling hurt by punishing herself or by defying or negating them.
Her dominant needs seemed to be the need for autonomy, achievement, recognition, aggression, and intra-
aggression. Her major conflict seemed to the conflict between autonomy vs compliance and id vs superego.
To deal with her conflicts, she is likely to use defense mechanisms of denial, avoidance and intellectualization.
Her problem solving skills seem to be poor (absence of outcome). She seemed to be in adequate touch with
reality (inclusion of all the central dominant parts of the pictures; absence of perceptual distortion).

2.
SSCT
The assessment was continued in the same room. The client was told that she will be given some incomplete
sentences which she has to complete based on the first thought that comes to her mind. To motivate her to
perform the test was presented as a test of creativity. After this the sentences were read out to her and her
responses recorded. This was followed by conducting an inquiry.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Her findings on SSCT revealed that she thinks that her father is a very hard working person but he needs to
take out more time for the family on week days too just the way he does on weekends. Her relationship with
her mother appeared to be strained as she saw her mother as someone who was often restrictive in nature and
too interfering in her life. She wishes her mother to work so that her mother has little time left to correct her
and to point out her errors or faults.
According to her, her parents, especially the mother, tends to unnecessarily worry too much about her studies
and weight and tends to repeatedly point out at it, though out of concern, but this leaves her feeling more
anxious and bitter. She also revealed that she herself wants to study hard and do well in her studies as she
wants to get selected in a reputed university. She added that she fears being obese and suffering from diabetics.
She also feels that her parents have high expectations from her which adds to her anxiety and irritation. She

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expressed her desire to have a more close, friendly and warm relationship with her mother to an extent that of
them are able to come to an agreeable solution in case of conflict but finds it difficult to do so.
She expressed the desire to have more freedom, independence and autonomy and wanted to break free from
the clutches of her parents. For instance, she desires to have a phone with a ‘sim card’ to be able to chat with
her friends but feels that her mother is quite restrictive and disciplinary in nature and would never allow this.
She doesn’t seem to be happy with herself in the present and believes that her childhood is not good as she
feels lazy and lonely being the only child. She believes that as a kid she was more desirable, attractive and
used to get more attention as compared to the present.
She appeared to be ambivalent about having a sibling as she desires to have all the joys but wants to shirk
away from the associated responsibilities and concerns. When it comes to making and maintaining friendships,
a similar kind of ambivalence was seen. She reported that she desires to have more friends but wants to keep
friendships with only those people who like her and understand her the way she wants and approve of her.
She seemed quite sensitive to peer rejections, disapproval and comments. She feels more than half of her
friends do not like her and do not bother about her. She also finds her peers more popular and political in
nature than her and hence may feel rejected at school. She added that her fear of failure and of being rejected
by others on seeing her flaws makes her avoid participating in various competitions and activities which she
would have otherwise liked to do.
She didn’t seem to like her present school and felt that her teachers are partial and finds it difficult to strike an
emotional bond with them. When faced with a problem she is likely to initially try and solve it but if this calls
for lot of effort she is like to engage in the defense of denial and avoidance and tends to evade from it. She
revealed that compared to her present, her future is likely to be better.

3. RPSIR
The assessment was continued in the same room. The client was told that she will be given a set of items.
Each item will have two options out of which she has to choose the one that she’d prefer to do more, or
prefer to not do less. And that this will help us understand what her areas of interest are. After this the
interest record was handed over to her and she marked the responses on the answer sheet.
Once the administration was complete, the scoring and interpretation was done as per the procedure given in
the Interest Record ManualInvalid source specified.. The findings were as follows:

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7.
Thought process
Nothing abnormal detected.
8.
Cognition

Orientation to time, place and identity were found to be normal.

No issues with memory were detected.

General intellectual level/Fund of Knowledge – normal

Abstract thinking – normal

Client was able to name specified objects and read/write complete sentences, understand and perform
a task, draw a simple map or copy a design/geometrical figure and distinguish between right and
left.
9.
Judgment
Normal
10. Insight
She is aware of her psychological issues completely and is willing to solve them.
III. PSYCHOLOGICAL TESTS ADMINISTERED
With the idea of obtaining a complete checklist of obsessive and compulsive symptoms the client may be
facing and to gain a better understanding of her inter-
and intra- psychic functioning, a detailed
psychological assessment was done. The following tests were administered:
4.
For OCD: Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
5.
For intra-psychic issues: Thematic Apperception Test (TAT)
6.
For intra-psychic issues: Rorschach Inkblot Test (RIT)
The tests were administered by my colleagues and the Agency Supervisor herself, while I got an opportunity
to observe. The details of the assessments are given below:
1.
Y-BOCS
The client was taken to a silent room so that she doesn’t get distracted while doing the assessments. While
going to the room she was
engaged in a general discussion to establish rapport with her. The assessment was

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conducted in the form of a structured interview based on YBOCS. Once the administration was complete,
the scoring and interpretation was done by the agency supervisor herself as per the procedure given in the
manual. The findings were as follows:
On Y-BOCS, the client obtained a subtotal score of 9 and 10 on obsession and compulsion rating scale
respectively. Her Y-BOCS total score was 19 suggestive of Marked Obsessive Compulsive Disorder (OCD),
where obsessions and compulsions occur at least one hour daily resulting in moderate to severe anxiety which
may significantly interfere with her social and occupational functioning.
She was seen to have excellent insight in her obsessions and compulsions. The client seems to engage in
avoidance behaviors to a moderate. She was also not seen to carry any overvalued sense of responsibility.
Though, she reported moderate degree of trouble in making decisions about minor things. Pathological
doubting was absent but a moderate degree of indecisiveness in the client’s behavior and thoughts was seen.
Her chief obsessions appeared to be the obsession with dirt and contamination which was followed by
compulsive hand washing ritual and covering nearly everything with polythene. She reported that repeated
thoughts of environmental contamination trouble her to such an extent that she tends to cover her mouth and
roll up the windows of the car when traveling. These obsessive thoughts sometimes make her avoid travelling.
On coming to her room from outside, she would ensure that she has washed her hands properly before touching
anyone and wants others too to wash their hands on coming from outside before touching her.
She tends to clean her mobile with the cleaner each time after coming home from outside and uses an excessive
quantity of a sanitizer while cleaning hands. She reported that she keep her nails short as she feels that nails
almost always contain dirt and also appears to take lot of care of cleaning her nails well while washing hands.
While washing he hands with the soap, she ensures that the foam is well formed up till her wrist and all the
steps of hand washing are carried out, although the sequence of steps does not matter. She tends to wash her
tooth brush, tongue cleaner etc. with soap before every use. However, while bathing, the sequence of cleaning
body from legs to neck or from neck to legs is important for her. She also tends to bath twice even in winters.
Before going to the workplace she tends to cover the bed sheet put on her bed with another bed sheet as she
feels that in her absence other people may sit on her bed and this might become a source of contamination. To
protect herself from or avoid skin infection, she changes her clothes that she was wearing while she was out
and put them on a different shelf in her cupboard. She does more so at her room in Gurgaon than in Delhi as
she feels that Gurgaon is a waste land and more polluted compared to Delhi.

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Presence of lizard anywhere in the room bothers her to such an extent that she tends to repeatedly check for
its presence, on the bed sheet etc. She even insists others to check the presence of the lizard in her room.
Obsessions of symmetry were also seen but they were not accompanied by magical thinking. She added that
sometimes she gets visual images of people hanging or their legs (especially at night) from the fan. These
obsessive images trouble her to the extent that she finds it difficult to stay in the room and tends to go to the
other room.
She further revealed that if she happens to see a word while crossing a road or while travelling, she continues
to re-look for it and if she fails to find that word again, she tends to imagine the same word, else she feels very
anxious.
In her conversation and while reading, she tries to avoid words like –‘retardation’, ‘failure’ etc. and tends to
replace them with other words meaning the same as she fears failure and seeing herself failing at anything. If
added that she fear using the word retarded as she believes that by using this word, she herself will become
retarded.
She also reportedly avoids number 3 and 13 and does not do any task 3 or 13 times especially at night. For
instance, while writing she will ensure her passage does not end at 3 or 13 points and would thus write and
additional point to make the number 4 or 14. Even while appearing for her exams, she would avoid a booklet
which is a multiple of 3 as she feel if she attempts that booklet, she will definitely fail. She also engages in the
compulsive checking or locks about 2 to 3 times despite knowing that she has locked her room properly.
2.
TAT
The assessment was continued in the same room. The client was told that she will be shown some cards and
he has to construct stories around the cards. The stories should cover the characters in the card, what they
are thinking and feeling now, what happened to them in the past and what will happen to them in the future.
After this the cards were shown to her one by one and the stories
recorded. This was followed by conducting
an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Client’s responses suggest
that she is an individual with average intelligence (presence of internal
consistency and logical development of stories; average vocabulary) whose emotional maturity level seems

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to be adequate (identified with the same age and same gender; stories are logical in harmony with the facts
of the stories).
Her personal (presence of greater negative emotions like anger, despair, sadness etc. than positive emotions
like happiness); family (conflict with mother) and social adjustment (significant degree of mistrust in her
interpersonal relationships) seems to be poor.
She was seen to carry ambivalent feelings towards her mother, where on one card she sees the mother figure
trying to strangle her daughter to death and the child seems to be scared of her mother, and on the same card
later sees the mother trying to play with her daughter.
Ambivalence in her interpersonal relationships was also seen. She seems to lack trust in interpersonal
relationships and may have difficulty trusting others. The hero of her stories feels that either of the partner can
betray or cheat on the other in an interpersonal relationship
Women in general were seen by her as submissive, shy, passive beings and men in general were seen as
aggressive, demanding people.
She comes across as an anxious, apprehensive, indecisive person who may carry significant feelings of
inferiority and low self-esteem and may carry feelings of self-doubt. She may also avoid doing or leaving
several things mid-way because of her fear of failure. She may have significant difficulty dealing with
emotions especially the negative ones. Presence of extreme opposing emotions was also seen.
Her dominant needs appeared the need for autonomy, achievement, aggression, intra-aggression, sex and
passivity. Her major conflicts were the conflict between autonomy vs compliance. Her major defense
mechanism seems to escape and avoidance.
Her ego functioning seems to be inadequate (inability to resolve conflicts, absence of outcomes) and she is
likely
to be in adequate touch with reality (inclusion of all the central dominant parts of the pictures; absence
of perceptual distortion).

3. RIT
The assessment was continued in the same room. The client was told that she will be shown some cards and
he has to tell whatever she sees on the cards. She can tell as many things as she wants. After this the cards
were shown to her one by one and her responses recorded. This was followed by conducting an inquiry on
the various responses.

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Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Her responses suggest that she may have an overriding intellectual ambition without the ability to back it up.
There may be emotional interferences with her ability to sense the essential interrelationships between the
various facets of her experience. This need for intellectual achievement may be viewed as a defense
mechanism of a compensatory sort. Her aspiration levels are too high but her productive resources of the
personality appear to be unduly low (W% > 30% with mediocre fo
rm level but organizational effort and W:M
ratio is 11:1).
Her responses on Rorschach suggest that she seems to be aware of and accepting of her affectional needs
experienced in terms of desire for approval, belongingness and response from others retaining a passive
recipient flavor (Fc responses).
Presence of c responses in her protocol indicate presence of infantile, undifferentiated crude need for affection,
of an essentially physical contact variety, indicating an insatiable need and a personality so undifferentiated
as to be able to find satisfaction in any interpersonal relationships. She may display an infantile dependence
on others (cF response) One possibility behind this, could be that there was a serious frustration of affectional
need in early childhood and that need remained an open problem, as it never got satisfied adequately.
In addition, presence of one ‘m’ responses in her protocol may indicate an awareness of forces that may be
outside her control and they threaten the integrity of her personality organization. FK responses indicate that
she may be trying to handle her anxiety by introspective efforts or by an attempt to objectify her problem by
gaining perspective on it or by putting it at some distance from herself so that she can view it dispassionately.
She may tend to act on her impulses without inhibition and may have little capacity for postponement
(FM>2M).
Sometimes the emotional tensions appear to be too strong to permit her from utilizing her inner
resources for the constructive solutions of her everyday problems of living (FM+m> M).
She may carry feelings of inferiority and depression (FC’ and C’ responses). She is likely to have a weak
control over her emotionality and may tend to act out her reactions in overt behavioral expression (CF+C>FC).
Presence of crude C responses, suggest a pathological lack of emotional control (Seeing Blood). Her
interpersonal relationships are likely to be poor (Presence of (H) responses) but she seems to be capable of
empathy in her relationships with other people (Seeing both M and Fc responses). She also seems to be
strongly moved to emotional reaction but is able to keep the response bottle-up without an overt expression.
As a result, she may appear to keep herself calm on the surface in public and may be inhibited (Csym).

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She is either inhibited in her productiveness under conditions of strong environmental impacts or is
basically
lacking in responsiveness to such an impact (% of responses to cards VIII, IX and X, if less than 30%). She
appears to be too occupied with pre-genital sexuality and may find it difficult to carry out heterosexual
relationships effectively (sex responses).
Presence of 5 popular responses indicate, that she is able to see the world as most people around her tend to
see it. In addition, her ability to view her world in an impersonal matter of fact may serve as an aid to controlled
adjustment (F% = 20% to % 50%).
IV. OTHER RELEVANT INFORMATION
-
V. OBSERVATIONS REGARDING CASE
Client was found to have marked Obsessive Compulsive Disorder along with intra-psychic conflicts:

OCD: Her Y-BOCS total score was 19 suggestive of Marked Obsessive Compulsive Disorder (OCD)
and should be considered to be diagnosed for F42.1 Predominantly compulsive acts [obsessional
rituals] of the ICD 10
(World Health Organisation, 1993).

Intra-psychic conflicts: The above test findings suggest that the patient is likely to have a poor
personal, social and family adjustment. Her dominant needs appeared the need for autonomy,
achievement, aggression, intra-aggression, sex and passivity. Her major conflicts were the conflict
between autonomy vs compliance. Her major defense mechanism seems to escape and avoidance. Her
ego-functioning seems to be poor and she is likely to be in adequate touch with reality.
VI. INTERVENTION REQUIRED

Pharmacotherapy is likely to benefit.

Cognitive behavior therapy is recommended to help deal with her conflicts.

Exposure and response prevention therapy is recommended to deal with obsessions and compulsions.

She needs to be taught effective coping mechanisms.

Emotion regulation skills need to be taught to the client

* * *

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and especially on that day he has so far never complained of loose motions. He also seems to engage in
constructive activities and spends most of his time studying, happily playing and watching television.
She revealed that all his physical examinations and reports of ultrasound seem fairly fine and there is a
possibility of some underlying psychological factors that may be contributing to his present condition.
Interaction with the mother and the child did not seem to reveal any apparent stressors or emotional conflicts
that may be contributing to the present condition. However, he expressed that he feels quite upset when
scolded, irrespective of the fact whether he was at a fault or not.
In what ways does this
cause inconvenience to the client? The child is not able to go to school. It is very
embarrassing for him as even his cousins and other family members make fun of him.
In what ways does this
cause inconvenience to the family members? Parents are worried about why this is
happening with their child. It is also embarrassing for them.
History of Present Illness
The mother reported that these issues surfaced all of a sudden two years back. And, it has now become a
serious concern. They are worried about their child. They thought it was a physical problem so they were
getting all medical examinations done. However, after all the reports came negative, somebody suggested to
them that this might be a psychological issues. They have not taken consulted any psychologist/psychiatrist
for this issue earlier. As per them the intensity of problems is at 9 on a scale of 10 as the child has become
dysfunctional
to the extent that he cannot attend school and socialise. The child’s fear of being scolded by
his parents and being mocked by his family members maybe a precipitating factor.
Birth and Developmental History
Normal.
All developmental milestones were reportedly attained on time -
no delays observed.
Relationships
The client’s relationship with the parents is okay –
however, the parents are authoritative because of which
he is scared of them. He is unable to express himself. He is a sweet amiable child –
however, he has difficulty
forming friends, and maintaining relationships beyond the family because of the dysfunctionality caused by
the issues he’s facing.

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
General intellectual level/Fund of Knowledge – normal

Abstract thinking – normal

Client was able to name specified objects and read/write complete sentences, understand and perform
a task, draw a simple map or copy a design/geometrical figure and distinguish between right and
left.
9.
Judgment
Normal
10. Insight
The child now has insight about the problem faced by him because of psychoeducation.
III. PSYCHOLOGICAL TESTS ADMINISTERED
In order
to gain a better understanding of his present condition, a detailed psychological evaluation was
done,
the following test was administered:
7.
For intra-psychic issues: Children’s Apperception Test (CAT)
The test was conducted by the agency supervisor herself while I had a chance to observe a number of follow
up sessions with the client and his mother.

The details of the assessments are given below:
CAT
The child’s responses on CAT suggested average intelligence (presence of internal consistency and logical development of stories; adequate organization level; average vocabulary).
Unlike his personal adjustment, his social and family adjustment seems to be adequate. He seems to be quite
closely attached to his mother and wants her to be always present with him in every circumstance and feels
quite helpless he does not find his mother around, especially in cases of conflict. Both the parents were seen
to be supportive and protective towards him. He was also seen to share a cordial relationship with both the
parents. However, he tended to show a significant amount of dependency on his mother and tended to feel
anxious and fearful when left on his own.

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His interaction with his peer mates seemed normal and healthy. But, he doesn’t seem to like being mocked
or laughed at by his fears and appears quite sensitive towards negative peer reactions.
Most of the stories made by him revealed that he is likely to feel quite upset when scolded irrespective of the
fact whether the hero was genuinely at fault or not and may tend to suppress anger out of fear of being
scolded. In some circumstances, he was seen to express his needs and take some actions to resolve his
conflicts but may soon repress his needs if he feels that they may not be met or he might get scolded for the
same. However, in some instances involving conflict, he may find himself helpless and is likely to desire his
mother to take a lead and resolve the conflict with others.
The hero of his stories may fear rejection from significant people in his life and may fear being left alone
and may want others to apologize and make up with him and agree to his demands. The hero may also
constantly fear that in case of problems or conflicts, he may be left alone and nobody will be able to help
him. This thought is likely to leave the hero feel helpless and make him believe that he always needs
somebody to depend upon (often his mother in such circumstances).
The hero of his stories was also seen to show a tendency to blame and hold others responsible for his pain,
hurt or troubles and may at times fail to see his own error and how he himself is responsible for his own pain
and troubles.
His dominant needs appeared to be the need for autonomy, aggression, intra-aggression (seeing injury to the
hero), and succourance. He tends to display passive aggression. His major conflict seems to be the conflict
between autonomy vs compliance and Id vs superego. The press seemed fairly supportive in nature.
Avoidance and suppression seem to be the major defense mechanisms adopted by him to deal with conflicts.
His ego functioning and problem solving skills seem to be poor (absence of clear outcomes). He seems to be
in adequate touch with reality (inclusion of all the central dominant parts of the pictures; absence of
perceptual distortion).
IV. OTHER RELEVANT INFORMATION
-
V. OBSERVATIONS REGARDING CASE
Client was found to have several intra-psychic conflicts which are resulting in psychosomatic issues.

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Intra-psychic conflicts:
The detailed clinical interview and the stories made by him on CAT clearly suggest
that he seems to have strong feelings of helplessness with a significant need to depend on his mother to help
resolve all his conflicts. He may also carry an irrational fear of being left alone or abandoned by significant
others in his life. His dominant needs appeared to be the need for autonomy, aggression, succourance and
intra-aggression. His major conflict seems to be the conflict between autonomy vs compliance and Id vs
Superego. Avoidance and suppression seem to be the major defense mechanisms adopted by him to deal
with his conflicts. His ego-functioning seems to be poor and he seems to be in adequate touch with reality. A
diagnosis of F45.32 Somatoform Autonomic Dysfunction of the Lower GastroIntestinal Tract as per ICD10
(World Health Organisation, 1993)
should be considered.
VI. INTERVENTION REQUIRED

The parents need to be duly educated

He needs to be made increasingly self-dependent

His confidence level needs to be worked upon

His irrational fears and negative emotions need to be addressed therapeutically

His emotion regulation skills and coping skills need to be worked upon.

CBT is strongly recommended.

* * *

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
Effective behavior modification strategies should be used to deal with his callous attitude

The child needs to be made responsible for his actions

His potentials need to be channelized in the right direction.
Recommendations for the School
3.
For deficits in academic areas

As per the CBSE guidelines, the child needs to be given extra time during exams and his marks
for spellings can be ignored, unless they are grossly wrong or are those of technical terms.

Remedial inputs by the special educator at the school can also be given.

An integrated approach towards learning would work best in the class room with additional
support and specialized instructions being provided to compensate for the weak areas.

Focus should be on assessing him, based on his conceptual knowledge.
4.
For behavioral concerns

His inappropriate ways of gaining attention should be ignored.

He should be praised for his appropriate behaviors.

BM techniques like time out and token economy can be used in school to deal with behavioral
issues.

His potential needs to be channelized in the right direction.

* * *

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
Ask child to repeat instructions before carrying it out to ensure that he has understood it clearly.

Avoid food items containing sugar and artificial colors as they are likely to increase the child’s
hyperactivity and inattention.

Positive home environment and support of the family members should be strengthened.

To reduce distractibility, while teaching him: use a corner setting, keep one book at a time on
the study table, give several short breaks and involve the child in the task.

Pharmacotherapy is likely to help
Recommendations for the School
For client’s inattention and poor concentration span

To prevent distractions client should be made to sit in the first bench of the middle row neither
near the window nor near the door, should be given one assignment or instruction at a time
p
referably in written, and, buddy system can be used for him.

One to one attention whenever possible can be given to him

As per CBSE guidelines, child should be given extra time in exams to help him perform better

His positive involvement in school and extra – curricular activities should be encouraged to
help build his self-esteem and self-confidence.

* * *

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9.
Judgment
Normal
10. Insight
He is aware of his substance abuse related issues.
III. PSYCHOLOGICAL TESTS ADMINISTERED
With the idea of obtaining a better understanding of his inter- and intra-
psychic functioning, a detailed
psychological assessment was done. The following tests were administered:
1.
For intra-psychic issues: Thematic Apperception Test (TAT)
2.
For intra-psychic issues: Rorschach Inkblot Test (RIT)
The tests were administered by the Agency Supervisor herself, while I got an opportunity to observe. The
details of the assessments are given below:
1.
TAT
The assessment was continued in the same room. The client was told that she will be shown some cards and
he has to construct stories around the cards. The stories should cover the characters in the card, what they
are thinking and feeling now, what happened to them in the past and what will happen to them in the future.
After this the cards were shown to her one by one and the stories recorded. This was followed by conducting
an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Cli
ent’s responses suggest that he is an individual with average intelligence (presence of internal consistency
and logical development of stories; average vocabulary) whose emotional maturity level seems to be adequate
(identified with
the same age and same gender; stories are logical in harmony with the facts of the stories).
His personal, family and social adjustment seems to be inadequate. His stories were filled with more negative
emotions such as sadness, rejection, aggression etc. than joy or happiness. There seemed to presence of conflict
with his parents, especially the father, who seen to be often angry with him. The mother seemed to be
psychologically absent.

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Significant degree of conflict in his interpersonal relationships was also seen - there seemed to be lack of
understanding and stability. Rejection by and of the opposite gender was seen.
He came across as a sad, confused, self-centered individual who seemed more concerned about his sensual or
id pleasures with minimal realization of personal responsibility and appears to pay too much emphasis on his
present. He did not seem to carry a deep meaningful bond with anybody and most of his relationships and
communications appeared to be largely need based. He appeared to be less concerned about the feelings of
others and seemed more self-engrossed. He seemed evasive and is less likely to dwell into the depths of any
issue at hand, in general. He was also seen to have a
tendency to always see faults in others and blame others
for one’s shortcomings, little acceptance of one’s own faults or shortcomings and
presence of shallow
superficial emotions.
His dominant needs appeared the need for acquisition, autonomy, aggression, intra-aggression and passivity.
In all his stories, the hero was unable to resolve his conflicts. Escape, denial and Avoidance seemed to be
some of the major defense mechanisms used by him to deal with his conflict of autonomy vs compliance
His ego functioning seemed to be inadequate (inability to resolve conflicts, absence of outcomes, presence of
varied outcomes) and he is likely to be in adequate touch with reality (inclusion of all the central dominant
parts of the pictures; absence of perceptual distortion).
2. RIT
The assessment was continued in the same room. The client was told that she will be shown some cards and
he has to tell whatever she sees on the cards. She can tell as many things as she wants. After this the cards
were shown to her one by one and her responses recorded. This was followed by conducting an inquiry on
the various responses.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Client’s
responses suggest that he seems to be aware of and accepting of his affectional needs experienced in
terms of desire for approval, belongingness and response from others retaining a passive recipient flavor (Fc
responses). His need for affection appears to have developed sufficiently well and is likely to be integrated
well enough with the rest of the personality organization, thereby assisting his interactions with other people
without implying a vulnerable over dependency on responses from others (FK+Fc = ¼ to ¾ F).

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He is likely to be ruled by an immediate need or gratification rather than by long ranging goals and tends to
act on his impulses without inhibition and may have little capacity for postponement (FM>2M). Presence of
FM+m>M in his protocol suggests that the tensions are too strong to permit him to utilize his inner resources
for the constructive solution of his everyday problems of living. In addition, presence of one or two m
responses in his protocol is indicates that he may be aware of forces outside his control, which may threaten
the integrity of his personality
organization.
Presence of FK responses in his protocol indicate an attempt by him to handle his affectional anxiety by
introspective efforts, by an attempt to objectify his problem by gaining perspective on it, by putting it at some
distance from himself so that he can view it more dispassionately. In addition, seeing K response suggests
presence of diffuse free floating anxiety reflecting a frustration of affectional satisfactions and the defenses
developed
by him to deal with his anxiety seem to be ineffective.
His socialized responses tend to be superficial, where he is either unable or unwilling to allow himself a strong
emotional reaction even when the situation demands a deep emotional response (FC>CF+C, if CF+C is absent
or nearly so) but he appears to be capable of empathy in his relationships with other people (Seeing both Fc
and M responses).
He seems to be an impulse person (FM responses) caring feelings of inferiority (FC’ responses, seeing skull)
who appears to be too hesitant in drawing general conclusions from fine and detailed observations as a way
of defending himself against insecurity by clinging to limited areas of certainty (Dd+S>10%). He may be
carrying a fear to go into anything too deep or a fear of becoming involved if one does, and thus displays a
tendency to skirt the fringe of a situation without coming to grips with
it (presence of de response).
An emphasis on dd responses in his protocol suggests presence of obsessional, meticulous or pedantic trends.
This could be a defense against insecurity through a quest for certainty and clinging to limited areas for a fear
of losing one’s grip and being carried away into confusion. He may carry a strong desire to do things
differently or of asserting himself stubbornly at too high a cost to his own balanced perception of reality
(Emphasis on S is exaggerated, particularly in main locations that reflect a daring use of S).
Presence of 8 popular responses indicate, that he is able to see the world as most people around him tend to
see it. However, his ability to view his world in an impersonal matter of fact way may serve as an aid to
controlled adjustment (F% = 20% to 50%). He tends to stick to practical, every day, common sense view of
things a
s he may not be capable of a more integrated view (D%>55%, with mediocre or poor form level).

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IV. OTHER RELEVANT INFORMATION
His father is not supporting the treatment completely. There was an instance where he gave the child Rs.
2,00,000 ‘just like it’
to have fun. While otherwise he has limited his stipend to only Rs. 8000 which maybe
low compared to the job he is doing.
He comes to sessions with one of the trusted employees of his father.
V. OBSERVATIONS REGARDING CASE
Intra-psychic conflicts: The test findings suggest that the client is likely to be an impulsive, evasive
individual with poor personal, family and social adjustment. His dominant needs appeared the need for acquisition, autonomy, aggression, intra-aggression and passivity. Escape, denial and Avoidance seemed to
be some of the major defense mechanisms used by him to deal with his conflict of autonomy vs compliance.
His ego functioning seemed to be inadequate.
VI. INTERVENTION REQUIRED

Pharmacotherapy is recommended.

Cognitive Behavior Therapy is recommended

Goal setting needs to be done

The client’s emotion regulation skills need to be worked upon.

He needs to learn to regulate his impulses.

He also needs to take ownership for his actions.

Parental counseling to help parents handle him tactfully is also recommended.

* * *

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79

III. PSYCHOLOGICAL TESTS ADMINISTERED
In order to understand her current level of functioning in the emotional sphere of life and to gain a better
understanding of her present condition, the following tests were administered:
3.
For intra-psychic issues: Children’s Apperception Test (CAT)
4.
For ADHD: Attention Deficit Hyperactivity Disorder Test (ADHDT)
The assessments were conducted by the agency supervisor herself, while I got a chance to observe.

The details of the assessments are given below:
1.
CAT
The client was taken to a silent room so that she doesn’t get distracted while doing the assessments. While
going to the room the client was engaged in a general discussion to establish rapport with her. The client was
told that she will be shown some cards and he has to construct stories around the cards. The stories should
cover the characters in the card, what they are thinking and feeling now, what happened to them in the past
and what will happen to
them in the future. After this the cards were shown to her one by one and the stories
recorded. This was followed by conducting an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
The child’s responses on CAT suggested average intelligence (presence of internal consistency and logical
development of stories; adequate organization level; average vocabulary).
In most of the stories made by her, the hero came across as a self-centered person who desires to do things
always her style her way even when she knows that her way of acting is incorrect and inappropriate. The hero
was seen to have significant difficulty dealing with loss, failure or rejection and was seen to display extreme
yet shallow emotions.
The child is likely to be more closely attached to her mother compared to the father. Presence of significant
conflict with the father was seen (death of the father on 2 cards).
She may have difficulty dealing with her negative emotions. Her dominant needs seemed to be the need for
autonomy, aggression, succorance, nurturance and affiliation.

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81

of F60.31 Emotionally unstable personality disorder –
Borderline type of ICD10 (World Health
Organisation, 1993)
should be considered.

Average probability of ADHD: ADHDT assessment indicates that the probability that he has
ADHD is
above average. Therefore, a diagnosis of F90.0 Disturbance of activity and attention as per
ICD10 (World Health Organisation, 1993)
should be considered.
VI. INTERVENTION REQUIRED
Recommendations for Parents
For client’s intrapsychic issues

Individual psychotherapy is recommended

Her emotion regulation skills need to be worked upon.

She should be allowed to express and vent her emotions freely and family members need to
listen to her concerns with a sensitive ear.
For client’s inattention and poor concentration span

Parents need to engage the child in brain gym exercises such as, grain sorting etc. to enhance
her
attention and concentration span.

Give child one instruction at a time.

Ask child to repeat instructions before carrying it out to ensure that she has understood clearly.

Avoid food items containing sugar and artificial colors as they are likely to increase the child’s
hyperactivity and inattention.

Positive home environment and support of the family members should be strengthened.

To reduce distractibility, while teaching her: use a corner setting, keep one book at a time on
the study table, give several short breaks and involve the child in the task.

Pharmacotherapy is likely to help
Recommendations for the School
For client’s inattention and poor concentration span

To prevent distractions client should be made to sit in the first bench of the middle row neither
near the window nor near the door, should be given one assignment or instruction at a time
p
referably in written, and, buddy system can be used for her.

One to one attention whenever possible can be given to her

* * *

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86

1.
Y-BOCS
The client was taken to a silent room so that she doesn’t get distracted while doing the assessments. While
going to the room she was engaged in a general discussion to establish rapport with her. The assessment was
conducted in the form of a structured interview based on YBOCS. Once the administration was complete,
the scoring and interpretation was done by the agency supervisor herself as per the procedure given in the
manual. The findings were as follows:
On Y-BOCS, the client obtained a subtotal score of 11 and 13 on obsession and compulsion rating scales
respectively. His total score was 24 suggestive of moderate degree of Obsessive Compulsive Disorder (OCD).
His primary obsessions were centered around excessive concern with fur of the dog, rat, rat kill, coil etc. The
mere thought of these things and the act of touching them seems quite disgusting to him. However, it is not
attached with any magical thinking. He has begun to avoid going to his cousin’s house because they had a dog
in their house, which is dead but the avoidance continues. He also tend to feel uncomfortable in the presence
of those cousins and would like to avoid meeting them if possible. He has also begun to avoid opening the
door of his room as his house faces street and there are several dogs on the road. Any such thought makes him
feel dirty following which he tends to repeatedly wash his hands with soap and
water till he feels satisfied.
Any image or thought of furry object tends to bother him and he revealed that he tends to get bothered by it
significantly as he likes to play with dogs but fails to do so. The thought troubles him so such an extent that
he avoids touching his belongings like phones, clothes etc as he thinks they will also become
dirty.
He also displays checking rituals such as checking the gas knobs in a multiple of four till satisfied. He tends
to repeatedly count money, or count/check things repeatedly that are of importance for others such as bills etc.
He was also seen to wash his hands 2 to 3 times before eating the food that he had ordered from outside as
eating such food without washing hands makes him feel incomplete and uncomfortable.
He further reported that he nearly spends 1 to 3 hours a day with his obsessive thoughts and compulsive
behaviors which tend to intrude and cause moderate anxiety and distress. This seems to cause moderate
impairment in his social and occupational performance.
He stated that he tends to usually yield to his compulsions and is able to execute little control on his obsessions.
His insight into his obsessions and compulsions seems to be excellent. Because of his obsessions and

Internship Report | MPCE015

87

compulsions the client has begun to start avoiding his social activities. The avoidance seems to extreme and
he appears to engage in self-doubting behaviors too.
2.
TAT
The assessment was continued in the same room. The client was told that he will be shown some cards and
he has to construct stories around the cards. The stories should cover the characters in the card, what they
are thinking and feeling now, what happened to them in the past and what will happen to them in the future.
After
this the cards were shown to him one by one and the stories recorded. This was followed by
conducting an inquiry on the various stories.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
Client’s responses suggest
that he is an individual with average intelligence (presence of internal consistency
and logical development of stories; average vocabulary) whose emotional maturity level seems to be adequate
(identified with the same age and same gender; stories are logical in harmony with the facts of the stories).
His personal and family adjustment is likely to be poor. His relationship with his father seemed to be better
than his mother. The father was seen as a supportive in nature whereas the mother was seen as rejecting in
nature. He seemed to have mentally distanced himself from his mother. Conflict in his parent’s marital
relationship was seen. His social adjustment seems to be fine.
Some degree of conflict in his interpersonal relationship was seen, where at one point he would find people
as fairly comforting in nature and at the other point would see them as mean or threatening in nature. He was
seen to have difficulty expressing his feelings and may have difficulty dealing with negative emotions. He
may carry feelings of self-blame and may hold self, responsible for causing distress to others. He is likely to
engage in avoidance behaviors in conflict situations and may come across as an anxious apprehensive person.
His dominant needs are need for achievement, acquisition, nurturance, abasement, aggression and affiliation.
He was seen to have significant difficulty expressing negative feelings. Approach vs avoidance conflict was
seen. Escape and Avoidance seem to be some of the major defense mechanisms used by him to handle conflict.
His ego functioning seemed to be inadequate (inability to resolve conflicts, absence of outcomes) and he is
likely to be in adequate touch with reality (inclusion of all the central dominant parts of the pictures; absence
of perceptual distortion).

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88

3. RIT
The assessment was continued in the same room. The client was told that he will be shown some cards and
he has to tell whatever he sees on the cards. He can tell as many things as he wants. After this the cards were
shown to him one by one and his responses recorded. This was followed by conducting an inquiry.
Once the administration was complete, the scoring and interpretation was done by the agency supervisor
herself as per the procedure given in the manual. The findings were as follows:
His responses suggest that he is an individual with an overriding intellectual ambition without the ability to
back it up. There is likely to be the presence of emotional interferences with his ability to sense the essential
relationships which do exist between the various facts of his experience. His need for intellectual achievement
may be viewed as a defense mechanism of a compensatory sort (W% >30% with mediocre from level but
organizational effort). There seems to be a gap between his aspiration and the ability to achieve, which is
likely to
lead to disappointment (W:M ratio approaches 3:1 or higher).
He seems to be aware of and accepting of his affectional needs experienced in terms of desire for approval,
belongingness and response from others retaining a passive recipient flavor (Fc responses). His need for
affection seems to have developed to such an extent that it threatens to swamp the rest of the personality. It
could be because of some early rejection experiences which might have inflated the need for being a recipient
of affection that a search for response from others plays an undue part in influencing his behavior (FK+Fc>
¾ F). He may have a need to be held and fondled and a longing for an infantile sort of dependence on others.
One possibility behind this could be, that in his early childhood, there might have a serious frustration of his
affectional needs (seeing c responses).
He is likely to be ruled by immediate need or gratification rather than by long range goals. He may tend to act
on his impulses without inhibition and may have little capacity for postponement (FM>2M). However, he is
likely to handle his affectional anxiety by introspective efforts, by an attempt to objectify his problems by
gaining perspective on him, or by putting it at some distance from himself so that he can view it more
dispassionately (Seeing FK responses).
Sometimes the emotional tensions appear to be too strong to permit him from utilizing his inner resources for
the constructive solutions of his everyday problems of living (FM+m> M). In addition, presence of one or two
m responses in his protocol is indicates that he may be aware of forces outside his control, which may threaten
the integrity of his personality organization. He may display a pathological lack of control over his emotions
and emotionality of explosive variety (Presence of C responses).

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89

His interpersonal relationships are likely to be poor (seeing only one H response) but he appears to be capable
of empathy in his relationships with other people (Seeing both Fc and M responses).
He seems to be an impulse person (FM responses) caring feelings of inferiority (FC’ responses). He is likely
to view his world in an impersonal, matter-of-fact way which may serve as an aid to controlled adjustment
(F% = 20% to 50%). Presence of 4 popular responses indicate, that he is able to see the world as most people
around him tend to see it.

IV. OTHER RELEVANT INFORMATION
-
V. OBSERVATIONS REGARDING CASE
Client was found to have marked Obsessive Compulsive Disorder along with intra-psychic conflicts:

OCD: Her Y-BOCS total score was 24 suggestive of marked Obsessive Compulsive Disorder (OCD)
and should be considered to be diagnosed for F42.1 Predominantly compulsive acts [obsessional
rituals] of the ICD 10
(World Health Organisation, 1993).

Intra-psychic conflicts: TAT and Rorshach test findings suggest that the patient is likely to be an
impulsive individual, carrying feelings of inferiority with poor personal and family adjustment. His
dominant needs appeared the need for achievement, acquisition, nurturance, abasement, aggression
and affiliation. He was also seen to have significant difficulty expressing negative feelings. Approach
vs avoidance conflict was seen. Escape and Avoidance seem to be some of the major defense
mechanisms used by him to deal with his conflict. His ego-functioning is likely to be poor and he
seems to be in adequate touch with reality.
VI. INTERVENTION REQUIRED

Pharmacotherapy is likely to benefit

Cognitive Behavior Therapy and ERP and cognitive drill therapy is recommended

The client’s emotion regulation skills need to be worked upon.

* * *

Internship Report | MPCE015

90

DISCUSSION

The internship at UPS has
been a great learning experience for me. It provided an opportunity to put the
theoretical knowledge
learnt during the theory classes into practice and develop skills necessary to become a
good practitioner.
The training goal was to help acquire professional acumen and skills in clinical
psychology under trained practitioners in the real-life
setting. This goal was successfully achieved.
Direct interaction with clients, doing the psycho-diagnostic assessments, observing sessions of various
therapies such as Cognitive Drill Therapy and Behavior Modification has not only helped in adding to my
knowledge but also built confidence that I would be able to handle such situations in the future. It was very
kind of the Agency Supervisor to allow me to independently conduct numerous assessments in
critical cases as her confidence in my knowledge and abilities grew.
Strategies were plann
ed and assessed during the internship to help clients from different settings to
overcome the mental health problems
faced by them. Also there has been a great learning about how to deal
with diverse population including children, adolescents and adults and learning to conduct tests and
assessments making proper interpretations of the results emerging from the testing.
A selection of ten cases out of those handled during the internship are presented in this report
along with
case history, Mental Status Examination and
suggested interventions. The depth of these case discussions
reflect the extent of exposure to the various kinds of client situations.
And, the variety is reflected in the
number of disorders covered. However, during the internship the primary set of clientele was young children
as that is area of specialization –
she’s a child psychologist.
Beyond the cases with clinical disorders. I also got to observe/handle cases related to relationship
counselling and career counselling. As sufficient cases
are present with clinical disorders to meet the
requirements of the internship report, I chose to skip them. There were no cases of terminal illness related
issues or old-age related issues that came in my presence.
Also, I would have liked to have greater exposure
to cases of schizophrenia, mood disorders, and personality disorders. However, considering the
specialization of UPS in child-care this was expected.
Overall, it was a great exposure. It would be great to complement it with further practical exposure in the
field of psychology in the future.

Internship Report | MPCE015

91

APPENDIXES

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97

Do you feel that a
particular thought comes into your mind again and again even though you don’t want it?
_______________________________________________________________________________________

Do you feel that sometimes a strange idea or feeling comes to your mind which is not correct and however
much you try it do
esn’t go? ________________________________________________________________
Do you have an impulse to keep washing
hands or check the lock on doors repeatedly even though you
know it is unwarranted? ___________________________________________________________________
VII. THOUGHT PROCESS
Irrelevant details
_________________________________________________________________________
Repeated words
and phrases ________________________________________________________________
Interrupted thinking
(thought blocking) _______________________________________________________
Loose or illogical connections
between thoughts ________________________________________________
VIII. COGNITION
Orientation to time –
what time is it now? _____________________________________________________
Orientation to place –
where are you? ________________________________________________________
Orientation to
personal identity – who are you? What is your name? ________________________________
Long term memory
– which school did you study in? ____________________________________________
Short term memory
– what did you have for breakfast? __________________________________________
Working memory
– count backward by threes._________________________________________________
General intellectual level/Fund of Knowledge –
who were the last five presidents? ____________________
Abstract thinking –
what does ‘old is gold’ mean? ______________________________________________
Ability to name specified objects and
read or write complete sentences. _____________________________
Ability to understand and perform a task
– please comb your hair/throw this ball______________________
Ability to draw a simple map or copy a design or geometrical figure
– square/triangle __________________
Ability to distinguish between right and
left – (touch left hand) what hand is this? _____________________
IX. JUDGMENT
What would you do if you found a sealed envelope on the road? ___________________________________
X. INSIGHT
Do you think you are ill? __________________________________________________________________

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100

REFERENCES
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-5

(5th ed.). Washington DC, London: American Psychiatric Publishing.
American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct.
Washington DC: American Psychiatric Association.
Benton, A. L. (1974). Revised Visual Retention Test -
Clinical and Experimental Applications. USA: The
Psychological Corporation.
Gilliam, J. E. (1995). Attention Deficit Hyperactivity Disorder Test.
Austin: Pro-Ed.
IGNOU. (2015). Handbook on Internship (MPCE-015, MPCE-025, MPCE-035).
New Delhi: Indira Gandhi
National Open University.
Kapur, John, Rozzario, & Oommen. (1991). NIMHANS Specific Learning Disability Battery.
Bangalore:
NIMHANS.
Narayan, J. (2003). Grade Level Assessment Device for Children with Learning Problems in Schools.
Secunderabad: National Institute for the Mentally Handicapped.
Ramalingaswamy, P. (1974). Manual of Indian Adaptation of WAIS-Performance Scale.
Delhi: Manasayan.
UPS. (2015). Current Level of Functioning Checklist.
Delhi: Unique Psychological Services.
UPS. (2015). Screening Checklist for ADHD.
New Delhi: Unique Psychological Services.
UPS. (2015). Screening Checklist for Asperger's.
Delhi: Unique Psychological Services.
World Health Organisation. (1993). The ICD-10 Classification of Mental and Behavioural Disorders:
Clinical Descriptions and Diagnostic Guidelines.
Geneva: AITBS Publishers and Distributors,
Delhi.

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